| NPI | 1316180300 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA P WEAVER Credentialing/Contracting 863-294-5505 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: FL ME73921) |
| Enumeration Date | 2009-04-07 |
| Last Update Date | 2011-07-18 |